Disclosure form and evidence of coverage - Kaiser Permanente ...

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covered care. When you get care, please bring your Kaiser Permanente ID card and a photo ID. Your medical record number is used to identify your medical records and membership information. Your medical record number should never change. Please call our Member Service Contact Center if we ever inadvertently issue you more than one medical record number or if you need to replace your Kaiser Permanente ID card. Your ID card is for identification only. To receive covered Services, you must be a current Member. Anyone who is not a Member will be billed as a non- Member for any Services he or she receives. If you let someone else use your ID card, we may keep your ID card and terminate your membership as described under "Termination for Cause" in the "Termination of Membership" section. Your Medicare card As a Member, you will not need your red, white, and blue Medicare card to get covered Services, but do keep it in a safe place in case you need it later. Getting Assistance We want you to be satisfied with the health care you receive from Kaiser Permanente. If you have any questions or concerns, please discuss them with your personal Plan Physician or with other Plan Providers who are treating you. They are committed to your satisfaction and want to help you with your questions. Member Services Many Plan Facilities have an office staffed with representatives who can provide assistance if you need help obtaining Services. At different locations, these offices may be called Member Services, Patient Assistance, or Customer Service. In addition, our Member Service Contact Center representatives are available to assist you seven days a week from 8 a.m. to 8 p.m. toll free at 1-800-443-0815 or 711 (TTY for the deaf, hard of hearing, or speech impaired). For your convenience, you can also contact us through our website at kp.org. Member Services representatives at our Plan Facilities and Member Service Contact Center can answer any questions you have about your benefits, available Services, and the facilities where you can receive care. For example, they can explain your Health Plan benefits, how to make your first medical appointment, what to do if you move, what to do if you need care while you are traveling, and how to replace your ID card. These representatives can also help you if you need to file a claim as described in the "Requests for Payment" section. Interpreter services If you need interpreter services when you call us or when you get covered Services, please let us know. Interpreter services are available 24 hours a day, seven days a week, at no cost to you. For more information on the interpreter services we offer, please call our Member Service Contact Center. Plan Facilities At most of our Plan Facilities, you can usually receive all of the covered Services you need, including specialty care, pharmacy, and lab work. You are not restricted to a particular Plan Facility, and we encourage you to use the facility that will be most convenient for you: • All Plan Hospitals provide inpatient Services and are open 24 hours a day, seven days a week • Emergency Services are available from Plan Hospital Emergency Departments as described in Your Guidebook (please refer to Your Guidebook for Emergency Department locations in your area) • Same–day Urgent Care appointments are available at many locations (please refer to Your Guidebook for Urgent Care locations in your area) • Many Plan Medical Offices have evening and weekend appointments • Many Plan Facilities have a Member Services Department (refer to Your Guidebook for locations in your area) • Plan Pharmacies are located at most Plan Medical Offices (refer to Kaiser Permanente Medicare Part D Pharmacy Directory for pharmacy locations) Plan Hospitals and Plan Medical Offices The following is a list of Plan Hospitals and most Plan Medical Offices in our Service Area. Please refer to Your Guidebook for the types of covered Services that are available from each Plan Facility in your area, because some facilities provide only specific types of covered Services. Additional Plan Medical Offices are listed in Your Guidebook and on our website at kp.org. This list is subject to change at any time without notice. If there is a change to this list of Plan Facilities, we will update this list in any Plan evidence of coverage issued after that date. If you have any questions about the current locations of Plan Facilities, please call our Member Service Contact Center. Page 22
Member Service Contact Center: toll free 1-800-443-0815 (TTY users call 711) seven days a week 8 a.m.–8 p.m. Northern California Region Plan Hospitals and Plan Medical Offices Alameda • Medical Offices: 2417 Central Ave. Antioch • Hospital and Medical Offices: 4501 Sand Creek Rd. • Medical Offices: 3400 Delta Fair Blvd. Campbell • Medical Offices: 220 E. Hacienda Ave. Clovis • Medical Offices: 2071 Herndon Ave. Daly City • Medical Offices: 395 Hickey Blvd. Davis • Medical Offices: 1955 Cowell Blvd. Elk Grove • Medical Offices: 9201 Big Horn Blvd. Fairfield • Medical Offices: 1550 Gateway Blvd. Folsom • Medical Offices: 2155 Iron Point Rd. Fremont • Hospital and Medical Offices: 39400 Paseo Padre Pkwy. Fresno • Hospital and Medical Offices: 7300 N. Fresno St. Gilroy • Medical Offices: 7520 Arroyo Circle Hayward • Hospital and Medical Offices: 27400 Hesperian Blvd. Lincoln • Medical Offices: 1900 Dresden Dr. Livermore • Medical Offices: 3000 Las Positas Rd. Manteca • Hospital and Medical Offices: 1777 W. Yosemite Ave. • Medical Offices: 1721 W. Yosemite Ave. Martinez • Medical Offices: 200 Muir Rd. Milpitas • Medical Offices: 770 E. Calaveras Blvd. Modesto • Hospital and Medical Offices: 4601 Dale Rd. • Medical Offices: 3800 Dale Rd. • Please refer to Your Guidebook for other Plan Providers in Stanislaus County Mountain View • Medical Offices: 555 Castro St. Napa • Medical Offices: 3285 Claremont Way Novato • Medical Offices: 97 San Marin Dr. Oakhurst • Medical Offices: 40595 Westlake Dr. Oakland • Hospital and Medical Offices: 280 W. MacArthur Blvd. Petaluma • Medical Offices: 3900 Lakeville Hwy. Pinole • Medical Offices: 1301 Pinole Valley Rd. Pleasanton • Medical Offices: 7601 Stoneridge Dr. Rancho Cordova • Medical Offices: 10725 International Dr. Redwood City • Hospital and Medical Offices: 1150 Veterans Blvd. Richmond • Hospital and Medical Offices: 901 Nevin Ave. Rohnert Park • Medical Offices: 5900 State Farm Dr. Roseville • Hospital and Medical Offices: 1600 Eureka Rd. • Medical Offices: 1001 Riverside Ave. Sacramento • Hospitals and Medical Offices: 2025 Morse Ave. and 6600 Bruceville Rd. E O C 1 Page 23
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